The concomitantly measured transfer of free cholesterol, esterified cholesterol, phospholipids and phosphoprotein from plasma into the aortic wall of stilboestrol-treated cockerels

Induction of Atherosclerosis by Human Chylomicron Remnants: A Hypothesis

Epidemiologic studies have provided support for the association between delayed remnant removal and premature atherosclerosis. Triglyceride-rich particles such as chylomicrons and chylomicron remnants that carry dietary derived fats, may play a role in the early stages of developing arteriosclerosis. Currently research focuses on these lipoprotein classes seeking distinguishing factors that causes some lipoproteins to be atherogenic while others are not. Such lipoproteins could be involved in atherogenesis directly or indirectly. Direct involvement occurs by interaction of triglyceride-rich particles with the arterial wall, possibly affecting the artery wall by oxidative stress, direct endothelial toxicity by constituents such as lysophosphatidylcholine or oxysterols, induction of prothrombotic changes, stimulation of endothelial expression of cell adhesion molecules and direct interaction with circulating blood cells. Indirect involvement refers to the influence of triglyceride-rich lipoproteins on other lipoproteins on the composition of low density lipoprotein (LDL) and high density lipoprotein (HDL) particles. We propose that in individuals with delayed removal of chylomicron remnants, the prolonged exposure of areas of endothelium that have been partially activated by turbulent flow, to specific components of the remnants, results in the endothelial cells becoming further activated and able to bind monocytes. During or shortly after the transcytosis to the intima and transformation of monocytes to macrophages, the macrophages become engorged with remnant derived lipids and form the nidus of a fatty streak.

In vivo transfer of lipoprotein(a) into human atherosclerotic carotid arterial intima

The aim of this study was to compare the atherogenic potential of lipoprotein(a) [Lp(a)] and LDL by measuring the intimal clearance of these two plasma lipoproteins in the atherosclerotic intima of the human carotid artery in vivo. Autologous 131I-Lp(a) and 125I-LDL were mixed and reinjected intravenously 3 hours before elective surgical removal of the arterial intima in four patients. The intimal clearance of Lp(a) and LDL was 229+/-48 and 405+/-127 nL/cm2 per hour, respectively (paired t test; P=.12). The mass accumulation of Lp(a) (114+/-32 ng/cm2 per hour) was on average one 15th that of LDL (paired t test; P=.06), mainly reflecting a low plasma concentration of Lp(a) compared with LDL in the human subjects studied. In accordance with our previous observation in rabbits, there was a positive association between the intimal clearance of LDL and that of Lp(a) (r=.97, P=.03). Accordingly, high plasma levels of Lp(a) may share with LDL the potential for causing lipid accumulation in the arterial intima in humans.

Extravascular circulation of lipoproteins: their role in reverse transport of cholesterol

The transfer of lipoproteins out of plasma into peripheral tissues, their flow through the interstitium and their return to blood has been reviewed. In this context special emphasis has been given to reports dealing with the movement of lipoproteins into and out of the wall of arteries.

In vivo transfer of cholesteryl ester from high and low density plasma lipoproteins into human aortic tissue

For the study of cholesteryl ester transfer from different plasma lipoproteins into human aortic tissue, patients scheduled for reconstructive aortic surgery were intravenously injected with autologous in vitro labeled lipoproteins 20 to 24 hours before aortic intima-media samples were obtained during the operation. The injectate contained high density lipoproteins (d greater than 1.063) labeled with 3H-cholesteryl ester and lipoproteins of lower density (d less than 1.063) labeled with 14C-cholesteryl ester or lipoproteins with the opposite labeling. In 16 aortic tissue samples (some with visible atherosclerosis) from 11 normocholesterolemic patients, the aortic influx of total cholesteryl ester was 1 to 50 nmol x cm-2 x day-1. Some 39% +/- 3% (mean +/- SEM) of the influx was derived from high density lipoproteins, which in plasma accounted for only 22% +/- 2% (mean +/- SEM) of the esterified cholesterol. The findings suggest that: 1) esterified cholesterol from the two lipoprotein fractions in plasma enter the aortic intima by the same mechanism, and 2) influx of cholesteryl ester from the smaller, high density lipoproteins is greater than influx from the larger, lower density lipoproteins considering their concentrations in plasma. In some patients, the cholesterol content in the intima-media tissue with no visible atherosclerosis corresponded to only a few months of continuous cholesteryl ester influx. This time is short considering the age of the patients and, therefore, indicates that removal of esterified cholesterol from the intima-media is of major importance in preventing cholesterol deposition in the arterial wall.

In vivo influx of free and esterified plasma cholesterol into human aortic tissue without atherosclerotic lesions

In order to determine the in vivo influx of plasma cholesterol into human aortic intimamedia tissue, specimens of the ascending aortic wall without visible atherosclerosis were obtained from patients undergoing aortic valve replacement. Before the operation the patients were intravenously injected with autologous plasma in which the lipoproteins were labeled with radioactive cholesterol. The influence of the duration of the exposure time (0.3-114 h) and of the distribution of radioactivity between free and esterified cholesterol in plasma on the amount of radioactivity found in the arterial wall was studied by the simultaneous use of 3H- and 14C-cholesterol. It was shown that the influx of free and esterified cholesterol into the intima-media layer of the tissue could be calculated from a set of linear equations that relate the labeled sterols in the tissue to the average specific activities in plasma. In nine patients between 50 and 70 yr of age with 4.2-5.9 mM total cholesterol in plasma, the influx of free cholesterol and of esterified cholesterol was 1.2-8.8 and 1.0-12.5 nmol X cm-2 X d-1, respectively. Both hydrolysis and esterification of the sterol fractions in the aortic tissue and exchange of free cholesterol between the plasma lipoproteins and the tissue were demonstrated. The cholesterol content of the intima-media layer was 0.6-2.3 mumol X cm-2. This corresponds to the influx of esterified cholesterol during a period of only 0.1-3.5 yr, which is short compared with the lifespan of the patient. Our data thus suggest that removal of esterified cholesterol from aortic tissue without visible atherosclerosis represents a major importance for the cholesterol concentration in the tissue.

Effect of chronic renal failure and methylprednisolone treatment on the uptake of labelled plasma cholesterol into the aorta of normocholesterolemic rabbits

The effects of chronic renal failure (CRF) and corticosteroid treatment on the aortic uptake of labelled free and esterified cholesterol (FC and EC) were investigated in normocholesterolemic rabbits. Methylprednisolone, 0.4 mg/day, or placebo was administered for 14 weeks to rabbits with normal renal function and with CRF. Then [3H]- and [14C]cholesterol were administered intravenously and orally, respectively. The radioactivity levels of FC and EC in plasma were measured at regular intervals. After 48 h the accumulation of 3H and 14C radioactivity of FC and EC in the intima-media of the thoracic aorta was determined. An aortic uptake coefficient was calculated by dividing the tissue radioactivity (dpm/cm2/h) by the mean plasma radioactivity (dpm/ml). The mean uptake coefficient of EC in normal rabbits was 6 nl/cm2/h, the value for FC being 180 nl/cm2/h. In normal rabbits treated with methylprednisolone the uptake coefficients of both FC and EC were significantly decreased to about 50% of the values in normal rabbits receiving placebo. A similar significant decrease in the uptake coefficients was found in the CRF rabbits receiving placebo. No further decrease was observed in the CRF rabbits treated with methylprednisolone. The cholesterol content of the aortic intima-media was significantly decreased only in CRF rabbits on methylprednisolone treatment. The results do not indicate an acceleration of uremic arterial disease by steroid treatment in the rabbit.

Arterial influx of esterified cholesterol from two plasma lipoprotein fractions and its hydrolysis in vivo in hypercholesterolemic rabbits

Arterial influx of esterified cholesterol from 2 plasma lipoprotein fractions, d less than 1.019 and d greater than 1.019, and influx of plasma free cholesterol were determined in each of 15 hypercholesterolemic rabbits with approximately the same plasma cholesterol concentrations but with different extents of arterial lesions. The procedure consisted of injecting intravenously into recipient rabbits [14C]- or [3H]cholesterol-labeled lipoproteins prepared from donor rabbits. The esterified cholesterol of one lipoprotein fraction was labeled primarily with one isotope and that of the other lipoprotein fraction was labeled with the other isotope. Thoracic aortas were removed 4-6 h after lipoprotein injections. The arterial influx of esterified cholesterol was up to 50 times higher in rabbits with maximal lesions than in those with minimal cholesterol deposits. the arterial influx of cholesteryl ester derived from d less than 1.019 lipoproteins was about equal to that derived from the d greater than 1.019 fraction. The amount of cholesteryl ester in plasma d less than 1.019 was approximately 3 times that in d greater than 1.019. Thus, per unit of cholesteryl ester concentration the d less than 1.019 lipoproteins delivered about 1/3 as much cholesteryl ester to the artery as the lipoproteins in the higher density fractions. some 5-40% of plasma esterified cholesterol which had entered the artery was hydrolyzed in the artery during the experimental period. The influx of free cholesterol that could not be accounted for by the influx of intact plasma lipoproteins was 5-80% of the free cholesterol influx. This excess probably represents free cholesterol influx by an exchange between the plasma lipoproteins and the intimal surface of the artery.

Transfer of plasma lipoprotein components and of plasma proteins into aortas of cholesterol-fed rabbits. Molecular size as a determinant of plasma lipoprotein influx

The arterial influx of esterified and free cholesterol from low density lipoproteins and very low density lipoproteins in 20 hypercholesterolemic rabbits was measured simultaneously by the use of lipoproteins labeled in vivo with [3H]- and [14C]-cholesterol. The simultaneous arterial influx of either [3H]-leucine-labeled very low density lipoproteins, low density lipoproteins, high density lipoproteins, or plasma proteins was also measured in each rabbit. The arterial influx was calculated as intimal clearance, i.e., the influx of a given fraction divided by its plasma concentration. The intimal clearance of low density lipoprotein esterified cholesterol was equal to that for the apolipoproteins of that fraction, which is compatible with an arterial influx of intact low density lipoprotein molecules. The intimal clearance of very low density apolipoprotein or cholesteryl ester was less than that for low density lipoprotein, whereas high density lipoprotein and albumin clearances exceeded low density lipoprotein clearance by 1.5- to 3-fold. The intimal clearances of plasma proteins, high density, low density, and very low density lipoproteins decreased linearly with the logarithm of the macromolecular diameter. This indicates that the arterial influx of three plasma lipoprotein fractions and of plasma proteins proceeds by similar mechanisms. Apparently the relative intimal clearances of lipoproteins are more dependent on their size relative to pores or vesicular diameters at the plasma-artery interface than on specific interactions between lipoproteins and the arterial intimal surface.

Arterial entrance and metabolism of free and esterified plasma cholesterol measured in vivo in experimental animals by a dual isotope method

The arterial walls of 3 cholesterol-fed rabbits were exposed for 3--4 hours in vivo to homologous cholesterol-labelled plasma with a 20-fold higher [3H/14C] ratio in esterified cholesterol (EC) than in free cholesterol (FC). The [3H/14C] ratio in total cholesterol (TC) in the thoracic aorta was 0.6--0.9 times the ratio prevailing in TC in plasma. This corresponds to a transfer from plasma into the arterial wall of relatively more FC, with the low ratio, than EC with the higher ratio. The [3H/14C] ratio in FC in the arterial wall was 1.4--2.0 times the ratio in FC in plasma. This corresponds to hydrolysis of some of the entered EC, adding cholesterol with the high ratio to FC with the lower ratio. The [3H/14C] ratio in EC in the arterial wall was 0.1--1.1 times the ratio in EC in plasma. This corresponds to no esterification in the arterial wall of entered FC. The same method applied to normolipidemic cockerels gave similar results. In a kinetic model the arterial influx from plasma of FC and EC combined (lipoprotein influx) corresponded in both groups to 20--90 nl plasma per cm2 arterial surface per hour with subsequent hydrolysis of 10--50% of the entered EC. The arterial influx of FC without EC (influx by exchange) accounted for 10--25% of the total influx of cholesterol in the rabbits and 40--70% in the cockerels.

Uptake of labelled free and esterified cholesterol from plasma by the aortic intima--media tissue measured in vivo in three animal species

Hyperlipemic stilboestrol-treated cockerels, cholesterol-fed rabbits and minipigs, as well as normolipemic cockerels and rabbits were injected intravenously with homologous plasma of corresponding lipid concentration labelled in vivo with radioactive cholesterol. The ratios between labelled free cholesterol and labelled esterified cholesterol in the intima--media from the thoracic aorta of these 5 groups of animals were respectively 1-, 2-, 8-, 2- and 20-fold greater than the corresponding average tracer ratio in plasma during the uptake period of 4--6 h. The intima--media tissue in the coronary arteries studied in one minipig contained 2--5 times more labelled cholesterol per mg wet weight than corresponding aortic tissue. This arterial uptake of labelled cholesterol in the minipigs was measured concomitantly with the uptake of phosphatidylcholine and plasma protein labelled in vivo. The uptake for these various tracers in the minipig suggested entry of labelled free and esterified cholesterol into the arterial wall, mainly as part of the plasma lipoproteins, with subsequent hydrolysis in the arterial wall of some of the cholesterol ester. In the stilboestrol-treated cockerels hydrolysis of cholesterol ester seems to be absent. The relatively higher uptake in the minipig of the labelled plasma protein (albumin) than of the lipoprotein (as traced by its lipids) suggests a molecular weight-dependent arterial entry of these plasma macromolecules.